Management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane: a case report.

BACKGROUND: Pregnancy management is difficult when pelvic organ prolapse already exists. During pregnancy, childbirth, and the days following, clinicians may come across situations that present management dilemmas. Here, we present conservative management of preexisting pelvic organ prolapse in pregnancy complicated with preterm premature rupture of membrane up to term. CASE PRESENTATION: A 35-year-old Ethiopian woman, gravida V, para IV, visited our emergency obstetrics and gynecology department at 32 weeks and 1 day of pregnancy in a prolapsed uterus on the 4th of April 2022. She was referred from primary hospital as a case of preterm pregnancy, pelvic organ prolapse, and preterm premature rupture of membrane after she presented with complaints of passage of clear liquor of 10 hours duration. She was successfully managed conservatively without application of pessary until she gave birth to a 3200 g healthy male neonate by elective cesarean section at 37 weeks of gestational age. At the same operation, cesarean hysterectomy was done. CONCLUSION: Women with preexisting pelvic organ prolapse complicated by premature rupture of membrane during the third trimester of pregnancy can be treated without the use of a pessary. Our case shows the importance of conservative management, which includes strict antenatal follow-ups, lifestyle modifications, and manual uterine reduction. Due to potential intrapartum problems from induction of labor with the occurrence of severe pelvic organ prolapse, we recommend cesarean delivery. However, to determine the optimal mode of delivery, additional comprehensive study with a large sample size is vital. If definitive management is warranted after delivery, we need to take a consideration of the status of prolapse, patient's choice, and family size.

Incidence, characteristics, and maternal outcomes of pregnancy with uterine prolapse.

BACKGROUND: Gravid uterine prolapse refers to abnormal descent of the uterus during pregnancy. It is a rare pregnancy complication and its clinical characteristics and obstetrical outcomes are not well understood. OBJECTIVE: This study aimed to assess the national-level incidence, characteristics, and maternal outcomes of pregnancies complicated by gravid uterine prolapse. STUDY DESIGN: This retrospective cohort study queried the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population was 14,647,670 deliveries from January 2016 to December 2019. The exposure assignment was the diagnosis of uterine prolapse. The coprimary outcome measures were incidence rate, clinical and pregnancy characteristics, and delivery outcomes of patients with gravid uterine prolapse. The inverse probability of treatment weighting cohort was created to mitigate the difference in prepregnancy confounding factors, followed by adjusting for pregnancy and delivery factors. RESULTS: The incidence of gravid uterine prolapse was 1 in 4209 deliveries (23.8 per 100,000). In a multivariable analysis, older age (≥40 years; adjusted odds ratio, 3.21; 95% confidence interval, 2.70-3.81); age from 35 to 39 years (adjusted odds ratio, 2.66; 95% confidence interval, 2.37-2.99); Black (adjusted odds ratio, 1.48; 95% confidence interval, 1.34-1.63), Asian (adjusted odds ratio, 1.45; 95% confidence interval, 1.28-1.64), and Native American (adjusted odds ratio, 2.17; 95% confidence interval, 1.63-2.88) race/ethnicity; tobacco use (adjusted odds ratio, 1.19; 95% confidence interval, 1.03-1.37); grand multiparity (adjusted odds ratio, 1.78; 95% confidence interval, 1.24-2.55); and history of pregnancy losses (adjusted odds ratio, 2.20; 95% confidence interval, 1.48-3.26) were the patient characteristics associated with increased risk of gravid uterine prolapse. Current pregnancy characteristics associated with gravid uterine prolapse included cervical insufficiency (adjusted odds ratio, 3.25; 95% confidence interval, 1.94-5.45), preterm labor (adjusted odds ratio, 1.53; 95% confidence interval, 1.18-1.97), preterm premature rupture of membranes (adjusted odds ratio, 1.40; 95% confidence interval, 1.01-1.94), and chorioamnionitis (adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.28). Delivery characteristics associated with gravid uterine prolapse included early-preterm delivery at <34 weeks' gestation (69.1 vs 32.0 per 1000; adjusted odds ratio, 1.86; 95% confidence interval, 1.34-2.59) and precipitate labor (35.2 vs 20.1; adjusted odds ratio, 1.73; 95% confidence interval, 1.22-2.44). Moreover, risks of postpartum hemorrhage (112.1 vs 44.4 per 1000; adjusted odds ratio, 2.70; 95% confidence interval, 2.20-3.32), uterine atony (32.0 vs 15.7; adjusted odds ratio, 2.10; 95% confidence interval, 1.46-3.03), uterine inversion (9.6 vs 0.3; adjusted odds ratio, 31.97; 95% confidence interval, 16.60-61.58), shock (3.2 vs 0.7; adjusted odds ratio, 4.18; 95% confidence interval, 1.41-12.40), blood product transfusion (22.4 vs 11.1; adjusted odds ratio, 2.06; 95% confidence interval, 1.34-3.18), and hysterectomy (7.5 vs 2.3; adjusted odds ratio, 3.02; 95% confidence interval, 1.40-6.51) were increased in the gravid uterine prolapse group compared with the nonprolapse group. Conversely, patients with gravid uterine prolapse were less likely to deliver via cesarean delivery compared with those without gravid uterine prolapse (200.6 vs 322.8 per 1000; adjusted odds ratio, 0.51; 95% confidence interval, 0.44-0.61). CONCLUSION: This nationwide analysis suggests that pregnancy with gravid uterine prolapse is uncommon but associated with several high-risk pregnancy characteristics and adverse delivery outcomes.

Unani Therapy in Fourth-degree Uterovaginal Prolapse With Multiple Decubitus Ulcers: A Case Report.

Context: Pelvic organ prolapse (POP) is a leading health problem, in which pelvic organs-the uterus, bladder, and rectum-bulge from the vagina, causing bladder and bowel dysfunction. Uterovaginal prolapse (UVP), Nutu-al-Rahim, affects more than 50% of parous women (women who have had children), especially those above 60 years of age. Objective: The current case study intended to evaluate the benefits of a holistic Unani treatment in ameliorating POP symptoms, healing decubitus ulcers, preventing further prolapse, improving quality of life, and maintaining social independence. Design: The research team developed a case report. Setting: The study took place at the National Institute of Unani Medicine in Bengaluru, Karnataka, India. Participant: The participant was a 70 year-old female patient at the Institute with backache, spotting from the vagina, foul-smelling vaginal discharge, general weakness, and fourth-degree UVP with multiple decubitus ulcers. Intervention: The participant orally received Majun Moocharus, 7 g twice daily for 60 days,and took sitz baths (Abzan) once daily for 20 minutes for 60 days, which used a medicated decoction of 3g of alum (phitkari ) and 10 g each of a medicated decoction (Joshanda) of nutgalls from the Aleppo oak, Quercus infectoria (Mazu), root of lemon grass Andropogan jwarancusa (Izkhar), and pomegranate rind from Punica granatum (Post anar). She also used vaginal tampons (Hamul) which each used 2g of the same medicinal powder with 10 ml of rose oil and which was inserted into her vagina once per day for 60 days, in combination with pelvic-floor-muscle exercises. Results: The ulcers were healed within a week. The monthly follow-ups for ten months showed no cervical descent or symptoms associated with it. Conclusions: The current case study found that a fourth-grade UVP can be managed effectively with Unani medications. The participant's ulcers were healed, her clinical symptoms of UVP were reduced, and her quality of life improved. Clinical trials are recommended with large sample sizes to create a higher level of evidence for the efficacy of the Unani medicine.

Postpartum Group A strep sepsis after third trimester uterine prolapse: case report and literature review.

INTRODUCTION: Uterine prolapse in pregnancy is an uncommon occurrence that can lead to a wide spectrum of complications. Postpartum Group A Streptococcus (GAS) endometritis is a rare but life-threatening condition. Our aim was to review the literature regarding management of prolapse in pregnancy and maternal infection as a rare complication. METHODS AND RESULTS: We present a case of uterine prolapse with cervical elongation presenting in the third trimester. The patient's prolapse was refractory to pessary management. She was induced at 36 weeks due to an abnormal fetal heart tracing and had an uncomplicated vaginal delivery. Her postpartum course was complicated by GAS endometritis and septic shock. She recovered after antibiotic therapy and her prolapse did not recur postpartum. CONCLUSION: Prolapse during pregnancy carries a risk of several complications but does not preclude a vaginal delivery. Management must be patient-centered and individualized. GAS sepsis is a potential, rare, and life-threatening postpartum complication requiring swift identification and treatment.

Vaginal pessary sharpens uterocervical angle in uterine prolapse during pregnancy. A case report.

A 37-year-old multiparous woman complained of uterine prolapse at 14 weeks of gestation. A silicone ring-shaped middle-size vaginal pessary (# 62 mm) was placed into the vagina to reduce prolapsed uterus. Because the cervical length became shortened at 25 weeks of gestation, we decided to start intramuscular administration of progesterone (250 mg) weekly. At 33 weeks of gestation, she complained of the vaginal pessary spontaneous falling out, so we inserted a vaginal pessary of the same size again. The uterocervical angle became acute, going from 100° to 60° after placing the vaginal pessary into the vagina. We took the vaginal pessary out at 37 weeks of gestation. The patient gave birth at 39 weeks by spontaneous vaginal delivery to a healthy baby. A vaginal pessary may help continue a pregnancy via the same mechanism as a cervical pessary, which sharpens the uterocervical angle.

Managing Reproduction Emergencies in the Field: Part 2: Parturient and Periparturient Conditions.

Selected conditions affecting broodmares are discussed, including arterial rupture, dystocia, foal support with ex utero intrapartum treatment, uterine prolapse, postpartum colic, the metritis/sepsis/systemic inflammatory response syndrome complex, and retained fetal membranes. Postpartum colic beyond third-stage labor contractions should prompt comprehensive evaluation for direct injuries to the reproductive tract or indirect injury of the intestinal tract. Mares with perforation or rupture of the uterus are typically recognized 1 to 3 days after foaling, with depression, fever, and leukopenia; laminitis and progression to founder can be fulminant. The same concerns are relevant in mares with retention of fetal membranes.

Current trends in pessary management of vaginal prolapse: a multidisciplinary survey of UK practice.

INTRODUCTION AND HYPOTHESIS: Symptomatic vaginal prolapse affects 6-28% of women and significantly impacts their quality of life. Pessaries for prolapse are used by three-quarters of clinicians as a first-line treatment; however, current clinical use in the UK is unknown and there is a lack of clinical guidance or training. This study is aimed at informing the upcoming UK Clinical Guidance on best practice for the use of pessaries document. METHODS: A 19-question, anonymised, electronic survey was sent to members of the nine professional bodies delivering pessary care in the UK. RESULTS: Of 917 respondents, 403 (246 nurses, 134 doctors, 22 physiotherapists and 1 other profession) currently deliver pessary care. PVC/vinyl ring, silicone ring, Gellhorn and shelf pessaries are most popular, and are used frequently by 93% of respondents. Further pessary training was deemed necessary by 62% of those currently providing pessary care, and 70% of those who do not. The most highly rated method for previous and future training is shadowing another clinician. One in three respondents receive no ancillary support and nearly 1 in 7 (predominantly nurses) report the absence of cross-cover arrangements, leaving a gap in care provision. CONCLUSIONS: Service provision, support and pessary training in the UK vary greatly. This calls for the standardisation of care, training and development of a national guideline. We present a clear rationale and need for a UK guideline on pessary management of vaginal prolapse and a standardised pessary training model for multi-professional use.

Pessaries (mechanical devices) for managing pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse is a common problem in women. About 40% of women will experience prolapse in their lifetime, with the proportion expected to rise in line with an ageing population. Women experience a variety of troublesome symptoms as a consequence of prolapse, including a feeling of 'something coming down' into the vagina, pain, urinary symptoms, bowel symptoms and sexual difficulties. Treatment for prolapse includes surgery, pelvic floor muscle training (PFMT) and vaginal pessaries. Vaginal pessaries are passive mechanical devices designed to support the vagina and hold the prolapsed organs back in the anatomically correct position. The most commonly used pessaries are made from polyvinyl-chloride, polythene, silicone or latex. Pessaries are frequently used by clinicians with high numbers of clinicians offering a pessary as first-line treatment for prolapse.  This is an update of a Cochrane Review first published in 2003 and last published in 2013. OBJECTIVES: To assess the effects of pessaries (mechanical devices) for managing pelvic organ prolapse in women; and summarise the principal findings of relevant economic evaluations of this intervention. SEARCH METHODS: We searched the Cochrane Incontinence Specialised Register which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 January 2020). We searched the reference lists of relevant articles and contacted the authors of included studies. SELECTION CRITERIA: We included randomised and quasi-randomised controlled trials which included a pessary for pelvic organ prolapse in at least one arm of the study. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed abstracts, extracted data, assessed risk of bias and carried out GRADE assessments with arbitration from a third review author if necessary. MAIN RESULTS: We included four studies involving a total of 478 women with various stages of prolapse, all of which took place in high-income countries. In one trial, only six of the 113 recruited women consented to random assignment to an intervention and no data are available for those six women. We could not perform any meta-analysis because each of the trials addressed a different comparison. None of the trials reported data about perceived resolution of prolapse symptoms or about psychological outcome measures. All studies reported data about perceived improvement of prolapse symptoms. Generally, the trials were at high risk of performance bias, due to lack of blinding, and low risk of selection bias. We downgraded the certainty of evidence for imprecision resulting from the low numbers of women participating in the trials. Pessary versus no treatment: at 12 months' follow-up, we are uncertain about the effect of pessaries compared with no treatment on perceived improvement of prolapse symptoms (mean difference (MD) in questionnaire scores -0.03, 95% confidence interval (CI) -0.61 to 0.55; 27 women; 1 study; very low-certainty evidence), and cure or improvement of sexual problems (MD -0.29, 95% CI -1.67 to 1.09; 27 women; 1 study; very low-certainty evidence). In this comparison we did not find any evidence relating to prolapse-specific quality of life or to the number of women experiencing adverse events (abnormal vaginal bleeding or de novo voiding difficulty). Pessary versus pelvic floor muscle training (PFMT): at 12 months' follow-up, we are uncertain if there is a difference between pessaries and PFMT in terms of women's perceived improvement in prolapse symptoms (MD -9.60, 95% CI -22.53 to 3.33; 137 women; low-certainty evidence), prolapse-specific quality of life (MD -3.30, 95% CI -8.70 to 15.30; 1 study; 116 women; low-certainty evidence), or cure or improvement of sexual problems (MD -2.30, 95% -5.20 to 0.60; 1 study; 48 women; low-certainty evidence). Pessaries may result in a large increase in risk of adverse events compared with PFMT (RR 75.25, 95% CI 4.70 to 1205.45; 1 study; 97 women; low-certainty evidence). Adverse events included increased vaginal discharge, and/or increased urinary incontinence and/or erosion or irritation of the vaginal walls. Pessary plus PFMT versus PFMT alone: at 12 months' follow-up, pessary plus PFMT probably leads to more women perceiving improvement in their prolapse symptoms compared with PFMT alone (RR 2.15, 95% CI 1.58 to 2.94; 1 study; 260 women; moderate-certainty evidence). At 12 months' follow-up, pessary plus PFMT probably improves women's prolapse-specific quality of life compared with PFMT alone (median (interquartile range (IQR)) POPIQ score: pessary plus PFMT 0.3 (0 to 22.2); 132 women; PFMT only 8.9 (0 to 64.9); 128 women; P = 0.02; moderate-certainty evidence). Pessary plus PFMT may slightly increase the risk of abnormal vaginal bleeding compared with PFMT alone (RR 2.18, 95% CI 0.69 to 6.91; 1 study; 260 women; low-certainty evidence). The evidence is uncertain if pessary plus PFMT has any effect on the risk of de novo voiding difficulty compared with PFMT alone (RR 1.32, 95% CI 0.54 to 3.19; 1 study; 189 women; low-certainty evidence). AUTHORS' CONCLUSIONS: We are uncertain if pessaries improve pelvic organ prolapse symptoms for women compared with no treatment or PFMT but pessaries in addition to PFMT probably improve women's pelvic organ prolapse symptoms and prolapse-specific quality of life. However, there may be an increased risk of adverse events with pessaries compared to PFMT. Future trials should recruit adequate numbers of women and measure clinically important outcomes such as prolapse specific quality of life and resolution of prolapse symptoms.   The review found two relevant economic evaluations. Of these, one assessed the cost-effectiveness of pessary treatment, expectant management and surgical procedures, and the other compared pessary treatment to PFMT.

[Surgical resection in a case of vaginal fold prolapse during oestrus in a Great Dane]. / Chirurgisches Vorgehen bei einem Vaginalfaltenvorfall in der Läufigkeit bei einer Deutschen Dogge.

The surgical procedure for a grade IV oestrogen-related vaginal fold prolapse in a Great Dane is described. Furthermore, the possibilities of conservative therapy for this disease are presented and a more recent surgical technique as well as the dog's postoperative course are discussed. The principle of conservative treatment is to shorten the bitch's cycle by means of medically inducing ovulation and thus subsequently reducing the influence of estrogens on the prolapsed tissue. Advantages of both therapeutic approaches are discussed. The presented case's interesting aspect is that conservative therapy did not lead to a successful outcome for which the cause is not clear.

Prolapso de los órganos pélvicos / Pelvic organ prolapse

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Expectant management of retained abnormally adherent placenta complicated by uterine prolapse after vaginal delivery.

The placenta accreta spectrum (PAS) describes invasion and adherence of the placenta onto or beyond the myometrium. Prenatal imaging improves management outcomes. In low- and middle-income countries (LMIC), however, the unavailability of ultrasonography in some health facilities delays the diagnosis, particularly if the prenatal period is asymptomatic. Following vaginal delivery, it often manifests as failure to remove a retained placenta manually. In the absence of haemorrhage, expectant management involving leaving the placenta in situ, is an option. In the presence of haemorrhage and/or sepsis, hysterectomy is usually recommended. We present a case of an expectantly managed PAS following a spontaneous preterm vaginal birth. The patient developed puerperal uterine prolapse with the placenta in situ, a previously unreported complication, but this was successfully reduced manually.

A comparison of the use of mesh to native tissue in the management of vaginal vault prolapse.

Vaginal vault prolapse afflicts millions of women and evokes significant psychosocial and pelvic floor dysfunction. The risk factors and modalities of conservative management are discussed in this study. There remains controversy in the optimal surgical management. This review serves to study the clinical conundrum of the decision-making process to utilize the mesh and the approach. In-depth evaluation of mesh-related postsurgical complications as compared to those associated with the native tissue is explored.

Treatment of vaginal vault prolapse in The Netherlands: a clinical practice survey.

INTRODUCTION AND HYPOTHESIS: A great variety of conservative and surgical procedures to correct vaginal vault prolapse have been reported. The aim of this study was to describe practice pattern variation-the difference in care that cannot be explained by the underlying medical condition-among Dutch gynecologists regarding treatment of vaginal vault prolapse. METHODS: A clinical practice survey was conducted from March to April 2017. The questionnaire was developed to evaluate treatment of vaginal vault prolapse. All members of the Dutch Society for Urogynaecology were invited to participate in a web-based survey. RESULTS: One hundred four Dutch gynecologists with special interest in urogynecology responded to the survey (response rate, 44%). As first-choice therapy for vaginal vault prolapse, 78% of the respondents chose pessary treatment, whereas sacrospinous fixation was the second most common therapy choice according to 64% of the respondents. Preferences on how to approach vaginal vault prolapse surgically are conflicting. Overall, the most performed surgery for vaginal vault prolapse is sacrospinous fixation, followed by laparoscopic and robotic sacrocolpopexy. CONCLUSIONS: Gynecologists in The Netherlands manage vaginal vault prolapse very differently. No standardized method could be determined for the treatment of vaginal vault prolapse in The Netherlands, and we observed practice pattern variations.

Second-Degree Burn Sustained After Vaginal Steaming.

BACKGROUND: Vaginal steaming has gained increased popularity as a method to achieve empowerment by providing vaginal tightening and to "freshen" the vagina. CASE: A 62-year-old woman sustained second-degree burns following vaginal steaming in an attempt to reduce vaginal prolapse. CONCLUSION: Clinicians need to be aware of alternative treatments available to women so that counselling may mitigate any potential harm.

Traditional Chinese medicine decreases the obstructive uropathy risk in uterovaginal prolapse: A nationwide population-based study.

Traditional Chinese medicine (TCM) is a popular treatment for voiding dysfunction in Eastern countries. However, no previous studies have investigated the effects of TCM on preventing obstructive uropathy in uterovaginal prolapse women. We conducted a large-scale nationwide population-based cohort study to investigate the relationship between TCM and obstructive uropathy in uterovaginal prolapse women. This is a retrospective cohort study with the Taiwan National Health Insurance Research Database (NHIRD). The study population was newly diagnosed uterovaginal prolapse patients between 1997 and 2010 year. Among patients, 762 uterovaginal prolapse patients in this cohort. Significant adjusted HRs of urine retention or hydronephrosis in Cox proportional hazard models were uterovaginal prolapse (hazard ratio [HR]: 1.74, 95% confidence intervals [CI]: 1.43-2.14), age 40 to 64 years (1.51, 1.01-2.27), ≥60 years (3.52, 2.32-5.34), DM (1.52, 1.23-1.89), hypertension (1.38, 1.13-1.7), constipation (1.35, 1.05-1.75), urinary tract calculi (1.54, 1.06-2.23), and TCM users (0.34, 0.28-0.41). The Kaplan-Meier analysis showed a higher incidence rate of urine retention or hydronephrosis in the uterovaginal prolapse cohort compared with that of the without uterovaginal prolapse cohort. The results of this nationwide population-based study support a relationship between TCM and a reduced risk of obstructive uropathy in uterovaginal prolapse women.

Effect of Uterosacral Ligament Suspension vs Sacrospinous Ligament Fixation With or Without Perioperative Behavioral Therapy for Pelvic Organ Vaginal Prolapse on Surgical Outcomes and Prolapse Symptoms at 5 Years in the OPTIMAL Randomized Clinical Trial.

Importance: Uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) are commonly performed pelvic organ prolapse procedures despite a lack of long-term efficacy data. Objective: To compare outcomes in women randomized to (1) ULS or SSLF and (2) usual care or perioperative behavioral therapy and pelvic floor muscle training (BPMT) for vaginal apical prolapse. Design, Setting, and Participants: This 2 × 2 factorial randomized clinical trial was conducted at 9 US medical centers. Eligible participants who completed the Operations and Pelvic Muscle Training in the Management of Apical Support Loss Trial enrolled between January 2008 and March 2011 and were followed up 5 years after their index surgery from April 2011 through June 2016. Interventions: Two randomizations: (1) BPMT (n = 186) or usual care (n = 188) and (2) surgical intervention (ULS: n = 188 or SSLF: n = 186). Main Outcomes and Measures: The primary surgical outcome was time to surgical failure. Surgical failure was defined as (1) apical descent greater than one-third of total vaginal length or anterior or posterior vaginal wall beyond the hymen or retreatment for prolapse (anatomic failure), or (2) bothersome bulge symptoms. The primary behavioral outcomes were time to anatomic failure and Pelvic Organ Prolapse Distress Inventory scores (range, 0-300). Results: The original study randomized 374 patients, of whom 309 were eligible for this extended trial. For this study, 285 enrolled (mean age, 57.2 years), of whom 244 (86%) completed the extended trial. By year 5, the estimated surgical failure rate was 61.5% in the ULS group and 70.3% in the SSLF group (adjusted difference, -8.8% [95% CI, -24.2 to 6.6]). The estimated anatomic failure rate was 45.6% in the BPMT group and 47.2% in the usual care group (adjusted difference, -1.6% [95% CI, -21.2 to 17.9]). Improvements in Pelvic Organ Prolapse Distress Inventory scores were -59.4 in the BPMT group and -61.8 in the usual care group (adjusted mean difference, 2.4 [95% CI, -13.7 to 18.4]). Conclusions and Relevance: Among women who had undergone vaginal surgery for apical pelvic organ vaginal prolapse, there was no significant difference between ULS and SSLF in rates of surgical failure and no significant difference between perioperative behavioral muscle training and usual care on rates of anatomic success and symptom scores at 5 years. Compared with outcomes at 2 years, rates of surgical failure increased during the follow-up period, although prolapse symptom scores remained improved. Trial Registration: clinicaltrials.gov Identifier: NCT01166373.

Medium-term follow-up after supervised pelvic floor muscle training for patients with anterior vaginal wall prolapse.

OBJECTIVE: The objective of this study was to determine changes in quality of life, urogenital symptoms, and adherence to pelvic floor muscle training (PFMT) for pelvic organ prolapse (POP) in the medium term. STUDY DESIGN: The present study conducted a pretest-posttest quasi-experimental study design. Of 29 participants in 4-month supervised PFMT, 27 completed all assessments in a follow-up study. Twenty subjects were included in final analysis except 7 participants who underwent surgery during follow-up. To evaluate urogenital symptoms, they completed a prolapse-quality of life (P-QOL) questionnaire and POP-specific QOL. A urologist evaluated the prolapse status of all participants with POP-Q. In addition, the participants were asked about their adherence to PFMT, PFMT obstacles, and where PFMT was performed. All outcome measures were assessed at the following three time points: before PFMT, immediately after PFMT with one-on-one session, and at follow-up via a phone call. Values of p < 0.05 were considered significant. RESULTS: Of the 29 participants in the 4-month supervised PFMT, 27 completed all assessments in a follow-up study (response rate: 93.1%). The percentages of patients who continued PFMT at least 4 times declined substantially in non-operated at follow-up compared with supervised PFMT period. POP-specific QOL such as general health, prolapse impact, and role limitation were significantly worse at follow-up compared with immediately after PFMT despite initial improvement in the short term (p < 0.05). CONCLUSION: POP-specific QOL gradually worsened compared with patients immediately after supervised PFMT in mild to moderate POP women who were followed up without surgery at a 2-year follow-up. Adherence to home-based PFMT might decline without further supervision. It might indicate that to PFMT would be required to maintain symptoms and QOL in medium term. Further study will be needed to clarify if PFMT is effective to improve urogenital symptoms and QOL in long term among the patients with POP.